| NPI | 1043535719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 18194) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 040267) |
| Enumeration Date | 2010-04-06 |
| Last Update Date | 2010-04-06 |